The entity of stress cardiomyopathy , other wise referred to as Takotsubo cardiomyopathy is a popular clinical entity in recent decades.The heart and mind are closely linked entities even though they are situated apart physically . Extensive neural and hormonal control mechanisms exist.

In extreme stress ,the hyper- sympathetic drive triggers a rush of adrenaline , which some how makes the left ventricle to bulge out !

The clinical features are varied .

It can exactly mimic an acute coronary syndrome .

ECG may show ST elevation and mimic an anterior STEMI

Echo shows a wall motion abnormality classically described as the apex alone dilates /Bulges or elongates

LV may acquire a shape of a banana. (See below )

A 45 year old man came to the ER with severe chest pain , dyspnea and minimal ST elevation in anterior leads. He was a smoker and was experiencing recent major office stress . Echo showed an elongated LV apex with some thinning .We made a diagnosis of stress cardiomyopathy .( It was disputed by my professor as the LV apex was contracting well ! but we learnt later there are many varieties of Takatsubo )

Echo showed an elongated LV apex with some thinning . Note the LV apex goes out of plane with RV apex.

Color Doppler revealed Trivial Mitral regurgitation

Follow up

He underwent coronary angiogram. Had no significant lesions , in 48 hours time the wall motion defect disappeared and was discharged with beta blockers.

Incidence

Up to 2 % of ACS could be related to Takatsubo . More common in women especially post menopausal , with stressful/emotional background like loss of loved ones.

Synonyms

Apical ballooning , Broken heart syndrome , Stress cardiomyopathy.

Mechanism

Not clear . Microvascular spasm , excessive catecholamines , are thought to be major culprits.